European Child & Adolescent Psychiatry最新文献

Given the increased demand for mental health resources in the child and adolescent population, this study aims to describe the emergency psychiatric care of the children and adolescents and to explore factors associated with multiple visits and hospital admissions. All patients < 18 years of age who visited the psychiatric ED(ED) of a University Hospital in Madrid, Spain, during 2022 were included. Data were collected by the attending psychiatrist upon first 2022 ED visit (index visit) and during any ED revisit. Electronic health records of all included patients were revised to contrast information and complete missing data. Logistic regressions and correlation analyses were used to explore factors associated with multiple ED visits and hospitalisations. N = 397 patients were included. Factors associated with multiple ED visits were: being LGTBQ+, having eating problems, substance use, consulting for psychosis upon first visit, having a history of suicidal behaviour, previous mental health service use or previous hospitalisations, having two or more psychiatric diagnoses, and being diagnosed of eating disorders or depression. Factors associated with hospitalisation include female gender, older age, LGTBQ+, family conflicts, first or second-generation migrants, history of abuse, eating problems, drug use, history of suicidal behaviour, previous mental health service use or previous hospitalisations, psychiatric comorbidity, and eating disorders diagnosis. Identifying predictors that lead to different clinical pathways and use of mental health services can improve clinical outcomes and resource use.

Anxiety symptoms and eating disorder symptoms commonly co-occur in adolescents. However, there is divergent evidence on the prospective relationship between the two factors. This systematic review and meta-analysis summarises the existing literature on the prospective and bi-directional relationship between anxiety symptoms and eating disorder symptoms in adolescence. A systematic search across six databases was conducted on the 11th June 2024. Studies were included if they assessed the prospective relationship between anxiety symptoms and eating disorder symptoms, or vice versa, in adolescence. 19,591 studies were screened, of which 54 studies met inclusion criteria and were included in the full review. Four meta-analyses were conducted. Anxiety symptoms were associated with subsequent eating disorder symptoms, increases in eating disorder symptoms, and higher odds of eating disorders, including their onset. Conversely, eating disorder symptoms were associated with subsequent anxiety symptoms, increases in anxiety symptoms, and higher odds of subsequent anxiety disorders. Current evidence suggests that anxiety symptoms and eating disorder symptoms do not merely co-occur during adolescence, but are prospectively and bi-directionally linked. Further research is needed to understand the underlying mechanisms of this relationship, as well as individual differences in symptom trajectories.

The aim of this study was to examine the neurocognitive deficits associated with the first episode of major depressive disorder (recent onset depression, ROD) in adolescents as compared to adult patients. Cross-sectional neurocognitive data from the baseline assessments of the PRONIA study with N = 650 (55.31% females) were analyzed. Based on a principal component analysis of eleven neurocognitive tests, we constructed an overall neurocognitive performance (NP) score. We examined mean score differences in NP between the groups of healthy controls (HC) and ROD and between adolescents (15-21 years) and adults (22-40 years) within a GLM approach. This accounts for unbalanced data with focus on interaction effects while controlling for effects of medication and educational years. Our results show lower NP for the ROD as compared to the HC group (d = - 0.29, p = .046) and lower NP for the adolescent group as compared to the adult group (d = - 0.29; p < .039). There was no interaction between these two group effects (F = 1.11; p = .29). Our findings suggest that the detrimental effect of ROD on neurocognitive functioning is comparable in adolescent and adult patients, since lower scores in adolescent patients are explained by effects of age and education. Neurocognitive impairment is an under addressed issue in clinical treatment guidelines for adolescent MDD. We suggest efficient monitoring in clinical practice by using an aggregate of the Digit Symbol Substitution Test and the Trail Making Test B, which highly correlated with the overall score of NP (r = 0.82).

It is unclear whether DNA methylation underlies the association between childhood maltreatment (CM) and non-suicidal self-injury (NSSI) in early adolescents. We aim to explore the mediation of specific DNA methylation sites in the associations of CM and its subtypes with NSSI, following investigation on the association between specific DNA methylation sites and NSSI. A case-control study was conducted to examine 155 adolescents aged 12-14 years who were identified to have engaged in NSSI and 201 controls. CM and its subtypes were evaluated by using the Childhood Trauma Questionnaire. The EPIC 850 k Bead Chip was used to discover differential methylation sites (DMSs) in the peripheral blood between 10 NSSI cases and 10 controls. Targeted pyrosequencing was employed to detect the levels of specific DMSs among the total study population, which were selected based on bioinformatics analyses and literature review. We discovered 456 DMSs between NSSI cases and controls, 219 were hypermethylated and 237 were hypomethylated. After controlling for potential confounders, CM or its subtypes, and the methylation of cg04622888 and cg05037505 were all significantly associated with NSSI (all P < 0.05). The total association of CM and its subtypes with NSSI were all significantly (all P < 0.05), with the standardized coefficient (β) ranged from 0.12 for physical neglect to 0.24 for emotional neglect and CM. Significant indirect association of physical neglect with NSSI through methylation of cg04622888 was observed and the mediating proportion was 0.14 (95%CI 0.06-0.23). Significant indirect associations of emotional abuse, emotional neglect, and physical neglect with NSSI through methylation of cg05037505 were also observed, and the mediating proportions were 0.09 (95%CI 0.04-0.14), 0.08 (95%CI, 0.03-0.14) and 0.19 (95%CI 0.07-0.32), respectively. Data of this study suggested that methylation of cg04622888 and cg05037505 were independently associated with NSSI among early adolescents, and they partially mediated the associations of emotional abuse, emotional neglect, and physical abuse with NSSI.

Emotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: "Treatment for Adolescents with Deliberate Self-harm"; http://ClinicalTrials.gov/;NCT00675129.

Depression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22-12.83), anxiety disorders (4.05; 1.77-9.27), suicidality (5.37; 2.28-12.66), and AUD (7.68; 2.59-22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21-0.95) and AUD in adulthood (0.18; 0.07-0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.

The COVID-19 pandemic has had profound effects on the mental health of children and adolescents worldwide, exacerbating existing challenges and introducing new stressors. This paper explores the impact of risk and protective factors on the mental well-being of young individuals during the pandemic. Using data from the German nationwide, population-based, longitudinal COPSY study (n = 2,471, girls: 50.0%, age 7-17 years) spanning nearly three years, this study investigates how factors such as gender, age, parental education, parental depressive symptoms, family cohesion, and social support influence mental health. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Latent growth analysis and structural equation modeling were employed to analyze cross-sectional and longitudinal data collected at five measurement points (initial response rate: 46.8%). Findings revealed that boys and younger children are at a higher risk for mental health problems. Additionally, low parental education, single parenthood, parental burden due to the pandemic and parental depressive symptoms were significantly linked with mental health problems in children. Conversely, personal resources, family cohesion, and social support were associated with less symptoms. Family cohesion additionally buffered against the negative impact of parental depressive symptoms. The study underscores the importance of multi-level interventions that consider individual, familial, and societal factors in promoting positive mental health outcomes among children and adolescents during challenging times. Continued research and collaborative efforts are needed to develop evidence-based strategies for supporting the resilience of young individuals in the face of future adversities.

Background: Rising rates of internalizing disorders and rising rates of school failure among adolescents are growing concerns. Despite the strong association between academic achievement and internalizing disorders, possible links between these two trends have not been investigated. Thus, the aim of this study was to investigate the development of the cross-sectional associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018.

Methods: Register data on specialist psychiatric care and prescriptions of psycholeptic and psychotropic drugs were linked to data on students' school grades in the last year of compulsory school. The total sample size was 3,089,674 students. Logistic regression models with internalizing disorders as the dependent variable, and graduation year and academic achievement as independent variables, were estimated.

Results: Throughout the period, there was a strong negative association between academic achievement and internalizing disorders. Low-achieving students had by far the highest risks of internalizing disorders. In absolute terms, the increase in internalizing disorders was clearly largest for low-achieving students. The relative risks for low-achieving compared to higher achieving students increased between 1990 and 2010 and declined after 2010.

Conclusions: This study found consistently large, and at least until 2010 growing, achievement-related inequalities in internalizing disorders among Swedish adolescents between 1990 and 2018, with the lowest achieving students having disproportionally high risks. The increasingly pronounced concentration of internalizing disorders in the lowest rungs of the achievement distribution suggests that preventive interventions should focus on supporting this doubly disadvantaged group of students.

Migration has been associated with both adverse and potentially beneficial mental health outcomes, with varying impacts on adolescents. With great flux in European migrations streams, an update is required of its effects on adolescent mental health. This systematic review provides an overview of the relationship between migration background (first, second, and third generation) and psychopathology for youth aged 12-25 living in Europe. A systematic search based on four concepts (i.e., mental health, human migration, European Union, and adolescents) carried out on Pubmed, Embase, Web of Science, Scopus, PsycArticles and Proquest Central led to the retrieval of 51 relevant studies published between April 2013 and August 2024. The present study was conducted and reported according to the PRISMA 2020 Checklist. Our systematic search found some evidence for the increased risk of mental health problems in people with a migration background, showing overall elevated risks for the development of psychotic experiences, psychosomatic symptoms, eating disorders, substance-related disorders and suicidal actions in the migrant population. Little consistent high-quality evidence was found for the effects of migration on any other mental health problems. Identified risk factors for adolescents with a migration background included being a first-generation migrant, low socio-economic status, low ethnic identification, and perceived discrimination. Results are mixed, but suggest that, overall, adolescents with a migration background have a mental health disadvantage. Intervention and prevention programs can be strengthened, not only by focusing more specifically on adolescent migrants, but also by considering the different contexts and experiences that put them at increased risk.

Many adolescents use internet games, and some of them experience psychological and social difficulties due to excessive gaming. Although there have been many studies on the onset and associated factors of internet gaming disorder (IGD) , research focusing specifically on its relapse is scarce. Considering that addictive disorders often have a chronic course with frequent relapse, this study prospectively observed adolescents from the general population to explore IGD recurrence rate and associated factors of recurrence. In this prospective cohort study, from 1587 middle school gaming users, 1452 (91.5%) were followed up at 12 months and 24 months. The results showed that the cumulative recurrence rate of IGD was 16.1%, which was higher than the initial incidence rate of 3.6%; the adjusted incidence rate ratio was 2.43 with 95% CI 1.21-4.87 (P = 0.012). In addition, starting internet gaming before entering primary school was associated with a higher risk of relapse (P = 0.004). Limiting internet gaming for children before they enter primary school may reduce the risk of relapse of IGD that they may encounter during their adolescent years.